Resistance pattern in drug-resistant pulmonary tuberculosis.

Author(s):Nagaraja C, Shashibhushan BL, Sagar C, Asif M, Manjunath PH

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Abstract BACKGROUND: Drug-resistant tuberculosis is an important issue for public health. There is a rise in the trend of drug-resistant tuberculosis, especially multi drug resistance (MDR), in different parts of world, India being one of the high burden countries. This study is undertaken to assess the various patterns of resistance among confirmed drug resistant pulmonary tubercular patients and to initiate second line anti tubercular treatment. AIMS AND OBJECTIVES: To assess various resistance patterns among confirmed drug resistant pulmonary tubercular patients and for the initiation of appropriate drug regimens in our setup. STUDY DESIGN: An observational prospective study. MATERIALS AND METHODS: This study was conducted at Rajiv Gandhi Institute of Chest Diseases, Bangalore between January 2005 and November 2010. A total of 309 drug resistant tuberculosis cases were studied. Sputum culture and drug sensitivity were carried out at National Tuberculosis Institute. Drug sensitivity testing done for all first line drugs, except pyrazinamide, by using LJ media. RESULTS: In this study, out of 309 patients, MDR pattern was observed in 224 (72\%), of which 20 (6.47\%) had resistance only to isoniazid (INH) and rifampicin (RMP), 58 (18.7\%) had resistance to INH, RMP, and either of the other first line drugs streptomycinor ethambutol and 146 (47.25\%) had resistance to all first line drugs. Poly drug resistance pattern was observed in 72 (23.3\%) and Mono drug resistance in 13 (4.2\%). CONCLUSION: In the present study the most common pattern observed is MDR with predominant resistance to INH. There is a rise in the number of drug resistant tuberculosis cases, especially MDR. Hence close monitoring of drug resistant pattern is required to formulate designs of different regimens in the treatment of drug resistant tuberculosis; especially MDR-TB based on accredited laboratory reports, in a specialized center which is very much essential for the betterment of the patients and the community.